title: Endosonography for suspected obstructive jaundice with no definite pathology on ultrasonography.
abstract: OBJECTIVE
  Ultrasonography (US) cannot demonstrate all the etiologies of biliary tract dilatation in patients with jaundice. Thus, we evaluated the etiologic yield of endosonography (EUS) for suspected obstructive jaundice when no definite pathology was found on US. Additionally, we sought to identify the predictors of the most common etiologies.
  
  
  METHODS
  We performed a retrospective review of 123 consecutive patients who had undergone EUS for suspected obstructive jaundice when no definite pathology was identified on US.
  
  
  RESULTS
  The most common diagnoses included no pathological obstruction (n = 43), pancreatobiliary malignancy (n = 41), and choledocholithiasis (n = 28). Pancreatobiliary malignancy was associated with common bile duct (CBD) dilatation, and fever and elevated alanine aminotransferase were predictors of choledocholithiasis (p < 0.05). The accuracy of EUS was 95.9% (118/123) for overall cause of suspected obstructive jaundice, 100% (40/40) for no pathological finding, 100% (23/23) for ampullary cancer, 100% (13/13) for pancreatic cancer, 75% (3/4) for CBD cancer, and 92.9% (26/28) for choledocholithiasis, respectively. Besides the two patients with focal chronic pancreatitis misdiagnosed as with pancreatic cancer, EUS missed the lesions in one CBD cancer patient and two patients with choledocholithiasis. The overall accuracy of EUS in ascertaining pancreatobiliary malignancy and choledocholithiasis was comparable (97.6%, 40/41 vs. 92.9%, 26/28; p > 0.05).
  
  
  CONCLUSIONS
  Marked CBD dilatation (≥12 mm) should remind us of the high risk of malignancy, and the presence of CBD dilatation and fever is suggestive of choledocholithiasis. Negative EUS findings cannot assure any pathological obstruction in patients with clinically suspected obstructive jaundice.
authors.affiliation: Digestive Disease Center, Changhua Show-Chwan Memorial Hospital, Changhua, Taiwan; Digestive Disease Center, Chang-Bing Show-Chwan Memorial Hospital, Changhua, Taiwan; Meiho University, Pingtung, Taiwan; Hungkuang University, Taichung, Taiwan.
authors.forename: Chien-Hua
authors.initials: CH
authors.lastname: Chen
authors.affiliation: Digestive Disease Center, Changhua Show-Chwan Memorial Hospital, Changhua, Taiwan.
authors.forename: Chi-Chieh
authors.initials: CC
authors.lastname: Yang
authors.affiliation: Digestive Disease Center, Changhua Show-Chwan Memorial Hospital, Changhua, Taiwan; Digestive Disease Center, Chang-Bing Show-Chwan Memorial Hospital, Changhua, Taiwan.
authors.forename: Yung-Hsiang
authors.initials: YH
authors.lastname: Yeh
authors.affiliation: Meiho University, Pingtung, Taiwan.
authors.forename: Tsang
authors.initials: T
authors.lastname: Yang
authors.affiliation: Meiho University, Pingtung, Taiwan. Electronic address: showchench@gmail.com.
authors.forename: Tieh-Chi
authors.initials: TC
authors.lastname: Chung
mesh_terms: D000368:Aged; D042883:Choledocholithiasis / Q000150:complications*; D003135:Common Bile Duct / Q000503:physiopathology*; D003138:Common Bile Duct Neoplasms / Q000150:complications*; D004108:Dilatation, Pathologic; D019160:Endosonography; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000000981:diagnostic imaging*; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications*; D012372:ROC Curve; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
keywords: choledocholithiasis; endosonography; obstructive jaundice; pancreatobiliary malignancy; ultrasonography